Provider Demographics
NPI:1255334736
Name:BULLARD, TRACY ELIZABETH (MD)
Entity type:Individual
Prefix:DR
First Name:TRACY
Middle Name:ELIZABETH
Last Name:BULLARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2600 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-3011
Mailing Address - Country:US
Mailing Address - Phone:910-272-3051
Mailing Address - Fax:910-738-3764
Practice Address - Street 1:1249 CHICKEN FOOT RD
Practice Address - Street 2:
Practice Address - City:HOPE MILLS
Practice Address - State:NC
Practice Address - Zip Code:28348-7525
Practice Address - Country:US
Practice Address - Phone:910-423-1278
Practice Address - Fax:910-423-2547
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2002-01439207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891368CMedicaid
NC891368CMedicaid